October 24, 2012

September 21, 2012

The “Cracking the Codes” stories are but the latest in a series of Center pieces that illuminate questionable Medicare practices and policies by marrying traditional shoe-leather reporting with rigorous data analysis.

The foundation of these pieces is the Center’s access to about two terabytes of Medicare claims data — data that was obtained by the Center in 2010 as the result of a settlement from litigation against the Centers for Medicare and Medicaid Services.

Delving deeply into this data has now helped us expose one of medicine’s dirty little secrets: medical providers garnering extra Medicare fees by “upcoding,” or billing for more extensive care than had actually been delivered. But it wasn’t easy. “Cracking the Codes” is the result of almost 20 months of often-tedious work.

That work began in early 2011, with preliminary analysis by data editor David Donald that summarized changes in hundreds of codes used by doctors and hospitals to bill Medicare over much of the past decade. Center investigative reporter Fred Schulte spent hours sifting those findings for story ideas, and subsequently discovered sharp spikes in higher-cost Medicare billing codes for routine patient visits to doctors. The code patterns indicated that short office visits paying doctors modest amounts had dropped off precipitously, while lengthier and higher-paid visits were rising dramatically. The trends ran counter to much of the medical research; the differences were costing taxpayers billions of dollars.

Under Donald’s direction, former Center data analyst Elizabeth Lucas then embarked on a six-month journey through millions of Medicare records to determine the extent of the billing anomalies and quantify the cost to taxpayers. The database was daunting indeed, consisting of scores of tables and thousands of columns, totaling more than 700 million claims.

As the details of the data dive began rolling in during the latter months of 2011, Schulte and reporter Joe Eaton — also a veteran of the health care beat — dove into the “nuts and bolts” reporting, interviewing health care policy and health care fraud experts, while simultaneously combing through policy papers, Medicare audits, investigative reports and litigation case files.

Data analyst Lucas departed in April for a position at Investigative Reporters and Editors, but the Center then received pro-bono help from Palantir Technologies, a Silicon Valley software company specializing in integrating, visualizing and analyzing information. Accommodating Palantir’s powerful servers required modification to the Center’s cooling facilities. Once those adjustments were completed, Palantir analysts Elizabeth Caudill, Daniel Tse and Lekan Wang — working at the Center and in Palo Alto — coordinated with Schulte, Eaton and Donald to marry further data analysis with more traditional reporting. Geographical analysis using the Palantir Gotham platform revealed the nationwide patterns of higher billing. Schulte then sketched the outlines of a three-part series, and the writing of the “Cracking the Codes” pieces began in the spring. Data editor Donald completed the data analysis in August.

The Team:

Lead reporters: Fred Schulte and Joe Eaton

Fred Schulte, who joined the Center in 2011, has been exposing questionable health care practices for decades. Schulte, a four-time Pulitzer prize finalist, spent much of his career at the Baltimore Sun and the South Florida Sun-Sentinel. He is the recipient of the George Polk Award, two Investigative Reporters and Editors awards, three Gerald Loeb awards for business writing and two Worth Bingham Prizes for investigative reporting .

Joe Eaton joined the Center in 2008. He previously served as a staff writer at the Washington City Paper and a reporter at The Roanoke Times.

Funding: “Cracking the Codes” pieces are generously supported by the Rita Allen Foundation, along with the Center for Public Integrity’s general supporters, including the Park Foundation, the John D. and Catherine T. MacArthur Foundation, and the Wyncote Foundation.

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